Breast implants are supposed to make you look good. If a cosmetic surgery procedure doesn’t give good results, what is the point of this expensive and somewhat risky procedure? There are a number of significant complications of breast augmentation, some of them medical, some of them cosmetic.
One of the most common cosmetic defects is known as bottoming out—when an implant sinks so that it sits completely below the breast tissue. The breast implant sinks below the nipple, turning the nipple up. If an inframammary incision was used, the incision can migrate up the breast as well. In sinking, the implant separates tissue from the chest wall. Left unchecked, the implant can continue to sink until it settles above the hips. Bottoming out may happen to one or both implants, and is often accompanied by visible wrinkling. The implant may also feel unnatural as a result of the high degree of scarring in the implant pocket. To reduce your risk, it’s important to know what to expect from your breast augmentation operation so you and identify when things are not going well.
CAUSES
Breast implants are initially placed very high on the chest, and take time to settle into place. Implants placed submuscularly take a little longer to settle into place. This accounts for part of the initial disappointment many women feel when they first see their breast implants, because it may have a somewhat unnatural shape at first, especially for women with initially small breasts, for whom the breast might look as if they have two breasts stacked one on top of the other. However, the breast implant settles and breast tissue distributes itself around the implant over the next four months to a year.
Bottoming out occurs when an implant loses internal support. The skin is not sufficiently strong to support the implant, so the implant needs additional tissue below it, including the natural supportive ligaments of the breast. Sometimes loss of support occurs if a woman has insufficient breast tissue to support the implant, or sometimes there is over-incision of the implant pocket, making the tissue unable to support the implant. No matter what the cause, the implant begins to sink.
REVISION
The only way to correct bottoming-out is through revision surgery. This may mean removing the implants and allowing a period of several months for the old pocket to heal. In less extreme cases, the implant pocket may be surgically revised. The pocket may either be doubled over on itself to seal the break or permanent sutures may be used to support the implant, both of which have consequences for remove and replace operations.
PREVENTION
The best breast augmentation result occurs when the implant must stay in its pocket. One crucial variable in breast enlargement surgery is the physicians’ skill. In choosing your plastic surgeon, consult a surgeon’s CV and consider patient testimonials to select a plastic surgeon that has a skilled breast augmentation technique for placing the implant. Ask the doctor about his or her actual complication rate, and see how it compares to the rates found during the implant manufacturer’s studies, available in their informed consent document.
Consider procedure variables that can reduce the risk of bottoming out. The transaxillary incision does not cut the bottom of the breast, or really very much of the breast tissue at all, so there is reduced risk of bottoming out, although there is increased risk of asymmetry following breast augmentation surgery. Submuscular placement also reduces the risk, and the likelihood of bottoming out can be completely eliminated if the implant is placed completely under the muscle. This uncommon placement does, however, have serious risks that might outweigh the benefits, so consult with your physician.
Make sure the implant size used is appropriate to the amount of breast tissue present preoperatively. An implant that is too large is more likely to bottom out. In addition, consider using silicone gel instead of saline because silicone gel implants are less dense than saline implants.
In addition, make sure you follow all your surgeon’s instructions for postoperative care. It is especially important to not rush back to exercises that can potentially put unnecessary stress on the bottom of the pocket. Make sure you wear an appropriate supportive bra following breast augmentation so that your tissue is not forced to bear the entire weight of the implant.
To learn more about breast augmentation surgery and risks, schedule a consultation with a local cosmetic surgeon.
